The EDI Work Group continues to promote the use of electronic transactions. During the WorkGroup’s last meeting it was decided to propose and submit a new Remittance Advice Remark Code (RARC) to the X12 Code Maintenance Committee (CMC). RARCs are used to provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or to convey information about remittance processing. The CMC is responsible for changes/additions to the RARC list. The proposed new code: ‘Missing Tooth Clause: Tooth missing prior to the member effective date’. This new denial reason is needed for scenarios where the prosthesis to REPLACE the missing tooth is not covered because the tooth was extracted before the member effective date. The CMC next meets at the end of January where this code will be considered. NADP will represent and defend the code at the meeting. Any questions please contact Brian Flynn, firstname.lastname@example.org .
The current RARC list may be found here: x12.org/codes/remittance-advice-remark-codes